Joan Burton (Dublin West, Labour)

At 8.30 a.m. tomorrow, an event on the calendar of the Dáil, which has been eagerly awaited since the general election, will take place. The event in question is one of the meetings — there are usually two per year — involving Members of the Oireachtas and Professor Drumm, the head of the HSE. Professor Drumm is expected to appear and give most Members the only glimpse they will probably get of the supremo of the health service. It will be a hot ticket. The meeting takes place in the private dining room and if it is similar to previous gatherings, there will be standing room only. People of all parties, ranks and distinctions from the Dáil and Seanad will crowd in to try to obtain some answers from the man for whom Members on all sides have much goodwill, particularly in the context of our hopes that some improvements will be brought about as a result of the allocation to his organisation of €15 billion.

As on previous occasions, I am sure Professor Drumm will be accompanied by some of his top advisers. I do not know if the Minister or the Ministers of State will be present. Certain members of the Government attended previous meetings and, like Opposition Members, they did so to ask questions. Even though they have privileged access to the notes from Departments to Members on the backbenches and Front Benches on the Government side of the House, they could not make sense of what was happening. The Minister must bear in mind that because of the crucial significance of the health service to everybody in this country, nobody on the Opposition has anything except a desperate hope and longing that some of what the Minister set out to do will improve the lives and chances of the men, women and children who use our health services.

I hope when the professor shows up in the morning with his top team at the top table they will have answers for us. On previous occasions they lectured us on what we as politicians lack in our attitudes and where we have not reformed robustly enough our mental approach to this issue. The professor outlines scenarios such as centres of excellence. We are all rational people. Nobody has a difficulty with the concept of a centre of excellence. However, we have a difficulty with the concept of a centre of excellence that will not exist until after 2009. In the meantime, what will happen to the poor little people who need excellence? Why, if one pays €50 to go to one's GP, is one not entitled to a sense of excellence? Everything we hear from the new structure is that mañana, next year and the year after we will have a health system with public confidence.

I examined closely comments made about the health system during recent weeks. The Taoiseach quibbled in his comments and replies to the leader of the Labour Party this morning when Deputy Gilmore mentioned four eminent people on the doctor consultant side of the health services who pointed out difficulties. At a conference yesterday, Professor Neligan stated the HSE chief and the Minister "have alienated all the caring professions, all the nurses, all the doctors, so it will be very hard to get dialogue and co-operation going again."

This is a disastrous indictment of the health service. I know from having worked as a Minister of State, and the Minister has enough experience to know, that the culture of the public services is very different from that of private industry and private business. If the workers in the health service, such as doctors, consultants, nurses and paramedics, do not acknowledge, recognise and look to the political and executive leadership, that leadership is in an extremely difficult situation.

The crisis in the health service is not simply down to the drive to modernisation and change, which is always difficult in any institution. Even politicians find changing constituency difficult. Change is not easy to manage. However, it is an incredible indictment that the people most proud of their contribution to the health services and who are well paid for it now indicate the system has large elements of chaos, shambles and lack of accountability.

Today, at the beginning of her contribution, the Minister was kind enough to make a full apology to the women and families involved. This is important and is a mark that the Minister, if not the Taoiseach, is prepared to accept some level of responsibility for what has happened, however detached.

I want to discuss the debate that took place in this House on creating the Health Service Executive. I recall the Minister and politicians in the Government parties arguing for key features to be built into the system. The new structures were to have a fundamental lack of democratic accountability because it was deemed by many of the interests in the old health board system, not least the civil servants and perhaps the Minister, that politicians at local level interfered too much.

I assume the Minister was the architect of the critical transfer of functions from the Minister for Health and Children to the chief executive of the new body, effectively reducing severely the role and accountability of the Department of Health and Children and the Minister. The manifestation of this is most alive to politicians through the public affairs division of the HSE. As far as I can see, it now occupies the entirety of space in Stewart's Hospital. Six or seven months later it answers queries which at times are so unreferenced that one can no longer work out what exactly they were about.

I defy anyone to understand the fuzzy management structure of the HSE. Earlier this week, Fintan O'Toole wrote in The Irish Times about the review done by the review body on higher remuneration where Professor Drumm, with Ministers, judges and the Garda Commissioner, received significant increases in their wages above benchmarking and the level of inflation. However, the review body on higher remuneration withheld similar increases to the second tier of managers in the HSE because it could not work out what they did. The reporting lines and the definition of their jobs were not clear. It could recognise that people work hard and to the best of their ability but without purpose in the context of an overall coherent plan. This middle level of managers grew by 37%, from 521 to 713, between late 2005 and June 2007. Most Dáil Members who attend a Health Service Executive function meet managers who are traumatised.

With regard to BreastCheck, the present position is difficult for women. They are damned if they go for a mammogram because of the major uncertainty — everyone who has had a mammogram has a doubt in the back of her mind about whether the results are as indicated — and they are also damned if they do not go because they are holding back. At present, the sense of trauma is such that women do not know what to do. Why go and be tested by a service that is so poor that perhaps it is better not to have it done? As Deputy Fleming stated, the people involved could save themselves endless stress. The system is in chaos and is a disgrace, but I thank the Minister for her apology.

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